Measure Description
The percentage of patients aged 50 years and older who have had the Shingrix zoster (shingles) vaccination
Instructions
This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided may submit this measure.
NOTE: This measure is appropriate for use in ambulatory/office-based settings. For each of these settings, there should be documentation in the medical record(s) that the Shingrix zoster vaccination was ever administered.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients aged 50 years and older
Denominator Criteria (Eligible Cases):
Patients aged 50 years and older on date of encounter
AND
Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0402, G0438, G0439
WITHOUT:
Telehealth Modifier: GQ, GT, 95, POS 02
AND NOT
DENOMINATOR EXCLUSION:
Patient pregnancy: M1061
OR
Patient immunocompromised: M1062
OR
Patients receiving high doses of immunosuppressive therapy: M1063
Numerator
Patients who have had a full course of the Shingrix zoster (shingles) vaccination ever documented in the medical record
NUMERATOR NOTE: The numerator is determined by examining immunization data recorded in the electronic health record, either in the immunization record, the procedures list of immunization administration/injection, and in the medication record of the vaccine. The quality action for this measure is not limited to the performance period since this vaccination may occur once within a patient’s lifetime. It is appropriate to review the patient medical history to determine if this vaccination was administered. Vaccinations administered on the denominator eligible encounter would also meet performance.
In order to meet performance for this measure, Shingrix must be administered according to the clinical guidelines which consists of 2 documented doses, administered intramuscularly, 2-6 months apart. If the clinician assesses the patient in October thru December of the current measurement year and is unable to administer 2 doses, then it would be appropriate to submit the denominator exception M1065.
Numerator Options:
Performance Met: Shingrix vaccine documented as administered or previously received (M1064)
OR
Denominator Exception: Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than Shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) (M1065)
OR
Performance Not Met: Shingrix vaccine not documented as administered, reason not given (M1066)